Getting started...

Over the past few months, I’ve been trying to get a small study off of the ground here. We want to look at urinary tract infections among pregnant women who come to the hospital for their care, as some markers of urinary tract infection were very high in previous studies. This is important because UTI during pregnancy increases the rate of preterm birth, low birthweight, and severe maternal kidney infection. Anyway, so I wanted to do a simple study where we collect the urine at the first prenatal visit, culture it for bacteria, and see what antibiotics the bacteria are sensitive to. Pretty simple stuff. Simple in the US, maybe, but not in Kenya.
I began the process for approval of the protocol in September of 2010. It was supposed to be an expedited review because it involves no risk to the patient. There have been some issues to missing signatures on the submissions, and as of now, it remains unapproved, though apparently it will go through any day now!

OK, so we’ve been working under the assumption that the approval will occur, so we needed to figure out the necessary reagents. I spoke with the clinical laboratory manager about what he would need to culture, identify, and determine sensitivities, as we’d provide the reagents. They need literally everything. From petri dishes to test tubes to agar to urine cups to distilled water to wash everything. The manager’s eyes lit up when I said that we’d purchase what we needed, as he is a well-trained laboratory technician who has been working with nothing for years. They are never able to definitively identify a pathogen, but rather treat based on what it most likely is. Alright, I guess we have some shopping to do.

I ordered a bunch of stuff from our wishlist from the US, but about half of the reagents couldn’t be shipped because they are flammable. One of the reagents was available from South Africa, though I got to the end of the ordering process, and shipping for the $200 agar (media on which you culture urine samples) was $300, which quickly ended that discussion. Mombasa has one supplier of laboratory goods, so the manager and I arranged to head in to Mombasa for the day. E and I usually take matatu-matatu-ferry-tuktuk into town, but because this was lab business, we took the lab truck, with Biego driving.

This shop is in Old Town Mombasa (read: very narrow streets, lots of mosques). We entered the tiny shop and sat down with Patel, the owner. This reference may be very new and lost on many, but it reminded me of in the movie “Inception” when they go to the guy’s shop in Mombasa. Wow, 98% of people reading this will get nothing out of that visual. Anyways, we sit down with Patel and begin to go through our list. He has about half of what we need, and another third he can get from Nairobi in a few days. Excellent. The following week Elisabeth and I did the usual public transport shtick and picked up the remaining reagents. E captured a picture of me in the shop.



Now that we have the reagents that we need, it’s just a matter of getting the women to pee in a cup, right? Wrong. Currently, the women are simply handed two cups (non-sterile) and told “pee in one, poop in the other”. As you can imagine, this is bound to lead to contamination. So, we have to get some clean catch urine collection instructions to them. I found some instructions online, but quickly realized that the vast majority of these women know no English. E and I then spent some time translating the instructions into Swahili. Two days ago I was sitting at our dining room table with our Swahili teacher correcting some grammatical errors. E left the room because, as you can imagine, there was some “sensitive” language and she didn’t want to offend our Muslim teacher. So, if anyone needs urine collection instructions in Swahili, we’re the people to talk to.

Once again, living and working here has made us so much more appreciative of the conveniences that we enjoy in the states. Amazon will deliver nearly everything you can dream of, to your door, in two days (or the next day if you want to pay a little more)! Here, even though we have people coming every few months from the lab, it is nearly impossible to get many “basic” items. Mzee was just complaining today that they can’t fix the lab trucks properly because they “cannot get spares”. I also recognize what a feat it is that the big research projects that I’m working on function at all!

A characteristic that one needs when trying to get anything done here (from a calendar hanging in the lab). E and I had a good laugh about this.